Provider Demographics
NPI:1245431543
Name:PEACE, BILLY JACK JR (RPH)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:JACK
Last Name:PEACE
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-1316
Mailing Address - Country:US
Mailing Address - Phone:903-567-4129
Mailing Address - Fax:903-567-6772
Practice Address - Street 1:300 S BUFFALO ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-1316
Practice Address - Country:US
Practice Address - Phone:903-567-4129
Practice Address - Fax:903-567-6772
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist